Summary

Most common specifically treatable and potentially curable form of hypertension, accounting for at least 5% of hypertensive patients, with most patients normokalemic.

Approximately 30% have unilateral forms correctable by unilateral laparoscopic adrenalectomy, and 70% have bilateral forms in which hypertension responds well to aldosterone antagonist medications.

Optimal detection involves screening all hypertensive patients using the plasma aldosterone/renin ratio, after controlling for factors (including medications) that may confound results.

In patients with repeatedly elevated aldosterone/renin ratios, definitive confirmation or exclusion of diagnosis involves careful suppression testing with measurement of aldosterone response to fludrocortisone or to salt loading.

Subtype differentiation for optimal treatment involves genetic testing for the hybrid gene causing familial hyperaldosteronism type I (glucocorticoid-remediable aldosteronism). A negative genetic test should be followed by adrenal CT and adrenal venous sampling to differentiate unilateral from bilateral forms.